Pediatric Breast Fibroadenomas: A Systematic Review and Algorithm for Treatment.

[BACKGROUND] Pediatric breast masses cause concern for both the patient and their family, although malignancy represents less than 1% of lesions in this population. No studies have systematically described resection and reconstructive methods for different sizes and locations of pediatric breast fibroadenomas. The aim of this study was to perform a recent systematic review of the literature regarding the surgical resection of pediatric breast fibroadenomas and to propose an algorithm for safe and effective treatment that maximizes both therapeutic and aesthetic goals while acknowledging possible future need for nipple-sparing mastectomy.

[METHODS] A search for the phrase "pediatric breast fibroadenoma" yielded 44 results through the PubMed database. Results were reviewed and filtered to only include pertinent articles published within the last 10 years, yielding 27 results. Application of exclusion criteria resulted in 5 applicable articles. A second search was conducted using the phrase "breast fibroadenoma AND resection," which resulted in 37 studies. Fourteen articles met the inclusion and exclusion criteria from this expanded search. All 19 articles were reviewed for techniques based on the characteristics of the masses in terms of their resection patterns, and a treatment algorithm was designed.

[RESULTS] Thirty-three female subjects with an average age of 14 years were included in analysis. The average number of fibroadenomas was 1.2. The average diameter of a breast fibroadenoma was 9.1 cm, with a range from 2 to 20 cm. Resection techniques were as follows: 31% (n = 6) periareolar incision, 31% (n = 6) inframammary fold incision, 21% (n = 4) reduction mammoplasty, 10% (n = 2) mastectomy, and 5% (n = 1) mastopexy. Sixteen percent (n = 3) of studies reported the use of implants or myocutaneous flaps when breast reconstruction was warranted. No articles described long-term follow-up with regard to need for eventual mastectomy or skin complications based on prior biopsy. Based on the results of this review, an algorithm was developed to guide treatment of pediatric breast fibroadenomas.

[CONCLUSION] This is the first time a treatment algorithm for surgical resection has been proposed in the literature. It is our hope that this systematic review will provide guidance to surgeons in the operative management of pediatric breast fibroadenomas.